Menopausal and Peri-Menopausal Nutrition: Getting back to basics!

Let me begin by saying I am not an expert in menopausal nutrition, which may lead you to ask why I’m writing a blog post on the subject.  The answer is simple.  I would like to try to quiet the noise in my brain and the brains of other midlife women who are attempting to keep up with the nonstop flow of information geared towards perimenopause and menopause.  Don’t get me wrong, I am extremely appreciative that there are studies being done on women, for women and that women’s health is gaining traction, in public arenas like social media, at the university level and beyond.  The problem is that as studies are published, each expert takes that scientific data and creates their own interpretation.  Those interpretations are spread across experts and non experts and then influencers are paid to tell us what to eat, how to exercise and what expensive supplements, gear and drinks we need to be our best selves.  Some of it may help, some of it may not, and truthfully we won’t know for quite some time, if we find out at all.  Nutrition is a flawed science.  Nutritional factors are impossible to isolate and each and every person is an individual with different nutritional needs. And this is why I decided to go back to the drawing board and look at the available science, giving us each a basic framework to build upon as we navigate the individual impacts perimenopause and menopause have on each of us.

So let’s start with why any of this matters and why we need a place to start.  Menopause is associated with increased obesity, metabolic syndrome, cardiovascular disease, & osteoporosis, all as a result of hormone changes. Yup, one more notch in the women are badass because they have to continually overcome biological gifts! The incidence of metabolic syndrome (obesity, dyslipidemia, glucose intolerance & hypertension) is 2-3 times higher after the onset of menopause.  Decreased estradiol levels cause an increase in energy consumption, insulin resistance in skeletal muscle and gluconeogenesis in liver, all of which leads to low grade, systemic inflammation.  In addition sarcopenia, the reduction of lean body mass, and sarcopenic obesity (reduction of lean body mass in association with obesity, either visceral (around your organs) or subcutaneous (noticeable)), accelerates after menopause.  The visual changes that women can start to see as early as 40, often cause distress which results in a high incidence of disordered eating. This often presents as binge eating in the perimenopausal group and restrictive eating in the menopausal group.  Additionally, there is a significant association between body image and severity of menopausal transition symptoms. So yes, there is a mental component to menopausal symptoms and there is zero shame in it…I mean we can only pile on the mental stress for so many years before it surfaces somewhere right?! Top all of this with the lack of sleep that plagues many mid life women and you’re left with increased depressive feelings and a lack of behavior control that creates a negative feedback loop.

Now it’s time to take this post in a positive direction and talk about the nutritional actions we can take to reduce the negative effects of hormone changes.  I will quickly state that I currently don’t have an opinion on hormone replacement as I have not done the research required to have one!*  Additionally, there are many great lifestyle suggestions, exercise research and supplements that appear to make a positive impact on women in midlife, but this post is a nutritional post only.

First and foremost, you need to eat enough food.  Consuming fewer than 1200kcal a day is not only hard to adhere to, but is highly associated with micronutrient deficiencies.  Most women will need a minimum of 1600kcal a day to meet their calorie and nutrient needs.  The first macronutrient I suggest you focus on is protein.  You need a minimum of 1 – 1.2 g/kg/day of ideal body weight, to maintain fat free mass.  Fat free mass is all components of your body aside from fat.  If you need to add muscle or bone density, you need more than 1.2 g/kg/day. My only exercise comment in this post is that you cannot add fat free mass, or keep it after age 30, without resistance training…period.  So protein is the most important nutrient and it needs to be associated with a form of resistance training.  If we consider that all women begin losing muscle mass after the age of 30, and that bone density decreases with age, we can assume that most of us will need more than 1.2 g/kg/day of protein. But based on the available science, a minimum of 1.2 g/kg/day should help you to maintain your current lean body mass. If you only want to start with one item, track protein and make sure you are consuming at least 1.2 g/kg/day.  As an example, this would be 77grams of protein for a 140 lb woman. 

The second nutrient that I would suggest focusing on is fiber.  30-50 grams of fiber is recommended for mid-life women.  Fiber helps to regulate blood glucose, slowing the absorption of carbohydrates, contributes to good bacteria in our gut which increases the metabolism of the estrogen we do have and contributes to an overall healthier GI system, which can start to go a little wonky during mid life.  Now, if you’ve been a little lax on your ingestion of fiber prior to now, please do not jump into 50 grams of fiber a day, as you will be cursing me due to bloating, cramping and possibly abdominal pain.  Work your way up slowly, giving your body time to adjust to processing this indigestible nutrient. We are not going to address carbohydrates much in this post as the minimum needed is 120 grams which you will consume if you hit your fiber targets.  

Hydration is crucial for aiding fiber on its path through the GI system and is the third area of focus for me.  The hormone fluctuations associated with the menopausal transition compromise fluid and electrolyte balance while also reducing the thirst sensation.  This means we need to make a more conscious effort to stay properly hydrated, which will help our bodies to distribute nutrients throughout our system, keep our GI tract working smoothly, and aid our aging skin to stay hydrated and healthy.  The minimum goal for hydration is 33 ml/kg/day, which is a little under 2 liters or 68 ounces for a 140 lb woman.  The majority of your fluid intake should be from plain water and while there is a good amount of controversy over the quality of tap water vs bottled water, I am not going to get into that in this post.  Unsweetened and uncaffeinated teas are also a great source of hydration.

This seems like the perfect place to discuss sugar.  There is no doubt that our midlife bodies become less efficient at processing sugar, causing spikes in glucose and increasing the incidence of glucose intolerance.  I am a ‘most things in moderation’ person and strongly believe in feeding our souls as well as our bodies, but I’m also very aware that limiting added sugars is a must if we want to optimize our nutritional intake and avoid the insulin sensitivity that a drop in hormones has a tendency to induce. The goal should be to consume no more than 50 grams of added sugar daily and preferably closer to 20 grams.  And I am talking about only added sugars, so sugars naturally occurring in fruits, vegetables and dairy are not included here.  It is important to consider that while 100% fruit juice has no added sugar, it will still cause a significant spike in blood glucose as all the fiber has been removed. 

The remainder of these numbers and recommendations are what I found in studies I trusted and are icing on the cake so I wanted to share in the event you want more!  When it comes to fats, focus on your Omega 3 fats first (fatty fish, nuts, seeds), then fats from olive oil and avocados, followed by other fats.  Calcium intake, for women who are post menopausal, is recommended at 1000-1200mg daily and supplements are not recommended based on risk for cardiovascular disease.  Dairy products are a great source of calcium and protein and most of your veggies will have some calcium also. If you are into canned fish, anchovies are an overall powerhouse of nutrients, including 300mg of calcium per 3 oz serving.  Crab, scallops and canned salmon all contain about 100mg per serving.  Vitamin D is critical for proper absorption of Calcium and it recommended that most people, but women especially, take a Vitamin D3 with K2 supplement of 2000IU’s.  The 100mg/day of recommended Vitamin C will be no issue at all if you focus on fiber intake through vegetables and whole grains.  B Vitamins are integral to our midlife health and are found in abundance in meat products and are also in many of the fiber rich legumes, grains and vegetables. Probiotic-containing foods are just starting to be studied in relation to menopausal health, but the early information seems to point to positive results in all aspects of mid-life women’s health.  Plain yogurts and kefirs with live cultures, kimchi and other fermented foods, as well as ‘real’ sourdough bread are all great sources of probiotics.  Soy proteins have been shown to be safe for everyone when consumed in the amount of 10-15 grams a day, but do try to source organic and non-gmo options as soy is one of the most highly chemically treated crops in the US.  Finally, cruciferous vegetables have been shown to have cancer prevention qualities in peri-menopausal and menopausal women.  

Now, I know that this is still an incredible amount of information and it’s important to remember that each of us will need varying foods, macronutrients and micronutrients to feel our best.  The numbers I’ve provided here should help you to establish a starting point which you can build upon. In my experiences and conversations with other women, most seem to feel best when getting protein consumption closer to 100g a day and over, but many who aim for 140 or more struggle to hit that goal which can induce a stress response for not hitting targets.  So start with attainable goals and build from there.  Over the next few weeks, I’m planning to publish one blog post a week, discussing each of these nutrients more specifically.  These posts should help to build a list of foods and ease your mind about how to obtain each of these in a way that you can feel good about, depending on factors that are important to you.  Stay tuned next week for my deeper dive into protein.

The below QR code or link will take you to a Menopausal Nutrition packet that I have put together.  This includes an outline of information provided above, all resources used to back up this information, a spreadsheet of food that I believe are nutrient dense for midlife women and a recipe book that includes nutrient dense ingredients.

I would love to hear from you!  What foods work best for you?  What questions do you have?  What more would you like to hear about?

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